Provider Demographics
NPI:1699570689
Name:TUELLER, ALISHA MICHELLE (CADC)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:MICHELLE
Last Name:TUELLER
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 TRAILS END
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-1231
Mailing Address - Country:US
Mailing Address - Phone:208-681-6404
Mailing Address - Fax:
Practice Address - Street 1:825 TRAILS END
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-1231
Practice Address - Country:US
Practice Address - Phone:208-681-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDADC-S111101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)